Loneliness has become a big issue in the time of the COVID pandemic. The attention to the topic also has to do with the increase in people living alone in Europe, although this also has to do with prosperity. Living alone does not yet mean being lonely. In the scientific discussion and especially in the measures, a differentiation must be made between loneliness, solitude and social disintegration. Poor social integration is easily measurable and has a lot to do with the physical health (mobility, vision and hearing) of the people concerned. However, the extent to which participation in social and cultural opportunities is possible, for example through the expansion of public transport, also plays an important role.

Loneliness, on the other hand, is by definition subjective and strongly linked to mental health. It describes the subjective suffering of missing or unsatisfactory social relationships, lack of integration and security. Loneliness is often found in two peaks, among the young and the old. Political and public health campaigns often focus on social integration measures. However, measures to combat loneliness mean first and foremost recognising mental illness in old age, especially depression. But they also mean providing help to people with long-term mental illness in old age.

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Patient-reported measures are a critical tool for improving policy and practice in mental health care. However, to date, the use of patient-reported measures in mental health care is limited to a small number of countries and settings—and there is a pressing need, both within and across countries, to consistently and effectively measure the effects and impact of care for patients who use mental health care services. The PaRIS pilot data collection on mental health included 15 data sources from 12 countries, collected over the course of 2021. While the scope of included data varied, the results demonstrate increased adoption of national and subnational efforts to capture patient-reported information in mental health care systems. Analysis of data collected through the PaRIS mental health pilot documents, in general, positive patient-reported experiences of mental health care. The results also suggest improvement in patient-reported outcomes for those receiving mental health care services.

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Stigma continues to be the main obstacle to the improvement of mental health care and to a life of good quality for people with mental disorders or with the experience of a mental disorder. It affects all that is related to mental illness, not only the person who has the disorder but also the institutions in which people with mental disorders receive treatment, treatment means, such as medications, staff working in mental health care and the family of the person with mental disorder.

Recent years have witnessed effective programs against stigma in various countries and it would be logical to expect that work against stigma will be a crucial part of mental health programs. This unfortunately is not the case.

The presentation will focus on interventions that have been successful in reducing stigmatisation or its consequences and propose action to reduce stigma.

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Traditional psychotherapeutic interventions show small to moderate effect in treating psychotic symptoms. Virtual reality (VR) assisted treatments has the potential of advancing current psychotherapies for psychotic symptoms by creating virtual environments that can elicit responses (e.g., thoughts, feelings, behaviours) mirroring real-world settings. This presentation will highlight the current research initiatives using virtual reality-based interventions targeting positive and negative symptoms in patients with psychosis.

Main findings from the pilot-studies and randomized clinical trials on computer-based and immersive VR-interventions demonstrate preliminary evidence of VR-based psychotherapy for treating auditory hallucinations and paranoia with large effect sizes (Cohens d= 0.75-0.80). Additionally, pilot data has provided indications as to VR-psychotherapy being feasible and acceptable in treating negative symptoms and may have a large effect on participants achieving their goals and potentially in reducing negative symptoms. No adverse effect has been found related to the VR-interventions.

The promising findings on VR-based interventions for psychosis calls for large-scale randomized clinical trials consolidating the evidence for the effect in treating positive and negative symptoms in psychotic disorders. Cost-effectiveness of these short-term VR-based interventions are essential to inform scalability and implementation. Finally, most of the studies target patients in more chronic/treatment resistant phases of psychosis highlighting the need to investigating the effect in earlier phases of psychosis, that is, first-episode and potentially clinical high-risk states.

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At the global level, women are more likely than men to misuse pharmaceutical drugs, particularly pharmaceutical opioids and tranquillizers. By contrast women are three times less likely than men to use cannabis, cocaine or amphetamines and one in five people who inject drugs are women.This mainly reflects differences in opportunities to use drugs owing to the influence of social or cultural environments, rather than intrinsic gender vulnerability. The scientific literature shows that processes of drug use initiation, social factors and characteristics affecting people who use drugs, biological factors and progression to the development of drug use disorders vary considerably between men and women. In this presentation we will present the main characteristics at bio-psycho-social level, including mental (i.e, Depression, Post- Traumatic Stress disorder) and physical comorbidities (i.e. HIV, HCV) of women with illicit drug use disorders. Finally, there will be a reflection on the different difficulties that women who use drugs have in accessing treatment.

M. Torrens Consultant of: MT has been a consultant/advisor and/or speaker for Gilead Sciences, Camurus, Servier, Adamed, Lundbeck, Otzuka, Angelini, Molteni

Social inclusion is a multidimensional concept, referring to ample participation in key social, cultural, economic and political activities. Since the turn of the century, social inclusion has become a guiding principle in policy recommendations of many international (United Nations, WHO, EU) and national bodies, aiming to improve the lives of people with mental ill-health. More recently, social inclusion has been increasingly used as an outcome measure, to test the effectiveness of complex interventions, especially in the field of global mental health.

This presentation will focus on: (1) current definitions and controversies in research on social inclusion for and with people with mental ill-health; (2) measuring social inclusion; and (3) the evidence-base of interventions to improve social inclusion. Special attention will be given to recovery-oriented interventions in global mental health such as peer support.

In summary, over the last years, impressive conceptual and methodological advances have been made to transform policy rhetoric into meaningful and effective interventions. However, challenges remain, including consensus on culturally appropriate measurement of social inclusion, and balancing the roles and responsibilities of all stakeholders (service users, mental health service providers, wider society) across the entire exclusion-inclusion continuum to promoting social inclusion and mental health.

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Physical activity (PA) has emerged as an interesting adjuvant non-pharmacological intervention in patients with schizophrenia (SZPs). The vast majority of programs are face-to-face without considering the patients’ physiological capacities and their difficulty to achieve the programs. The aim of this study was to demonstrate the efficacy of PA on clinical variables and brain plasticity. Its originality was to adapt PA on the cardiorespiratory and physical capacities (APA) and to deliver PA remotely by a videoconference coach (e-APA).

This longitudinal study included 35 SZPs (DSM-5) randomized either in an e-APA group or in a control group (health education training (e-HE)). Both programs were delivered in the same conditions, remotely via the web with a professional, for two 60-minute sessions per week during 16 weeks. Cardiorespiratory capacity measured by VO2max, clinical symptoms assessed with PANSS, BNSS and SNS, total hippocampus (HCP) volumes and their subfields, were evaluated in pre- (session 1) and post- interventions (session 2). High-resolution T1-weighted and two high-resolution T2w brain volumes were proceeded at session 1 and 2 (MRI 3-T, Philips). ANCOVAs were performed to determine intervention and/or diagnostic effects on relative variation (RV) of cardiorespiratory capacity, clinical symptoms and HCP volumes.

The retention rate of SZPs in the study was 88.6%. SZPs of e-APA group presented a greater RV of VO2max (+7.3%) compared to SPZs-HE (-3.9%) (p = 0.024). No significant effect of the e-APA compared to the e-HE was demonstrated regarding the RV of the clinical symptoms. However, between 1 and 2 sessions, total PANSS scores, positive and general PANSS sub-scores significantly decreased in both groups while total SNS and BNSS scores only decreased in e-APA group. Finally, a positive and greater RV of the left subiculum volume was observed in e-APA (+3.4%) compared to e-HE (-2.5%) (p = 0.0005).

This study is the first one demonstrating the feasibility and acceptability of a remote APA program in SZPs with high participation rates. Our results show that e-APA induces brain plasticity reflected by an increase of HCP subfield volume and improves the cardiorespiratory capacity in SZPs. This study underlines that remote APA represents an innovative, original, safe and effective adjunctive therapeutic strategy in schizophrenia.

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Behavioral addictions, also known as non-substance or non-drug addictions, refer to a range of compulsive behaviors that individuals engage in despite the negative consequences that result from these behaviors. Research on behavioral addiction in women has shown that women are at a higher risk for certain types of behavioral addictions, such as shopping addiction and internet addiction, compared to men. Studies suggest that women may be more susceptible to these types of addictions because of social and cultural factors, such as societal expectations of women to be nurturing and caregiving, which may lead them to use these behaviors as a form of coping mechanism. There is also evidence that women are more likely to experience shame and guilt as a result of their addiction, which can make it more difficult for them to seek help and support. Gambling among women has traditionally been less common than among men however, this trend is changing. Survey have shown that the number of women who gamble is on the rise, and that they are becoming increasingly diverse in terms of age, income, social background. Research studies have found that the rate of problem gambling among women is lower than men, but that women tend to develop gambling problems more quickly than men. This is thought to be due to a number of factors, including women’s greater vulnerability to stress and depression, as well as the fact that women are more likely to have a history of trauma or abuse. Overall, research on behavioral addictions among women is still a relatively new field, and there is a need for more studies to be conducted in order to better understand the unique factors that contribute to the development of these types of addictions in women.

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Purpose: loneliness in adults increases with age. Although loneliness has been found to be associated with psychiatric disorders and dementia, no information is available on prevalence of loneliness in older psychiatric patients. Given the negative consequences of loneliness for morbidity and mortality, identification of specific populations vulnerable to loneliness is important. The aims of the present research were to examine prevalence of loneliness in older psychiatric outpatients, including gender differences and associations with psychiatric disorders and with social situation.

interviews were done in 181 patients from an outpatient clinic for geriatric psychiatry between September 2013 and February 2018, using questionnaires regarding loneliness, depression, anxiety, frailty and alcohol use.

prevalence of loneliness was as high as 80%. Loneliness was associated with having less social contacts, in women only. There were no associations with DSM-IV-TR-classifications. However, loneliness was associated with higher scores on a depression questionnaire. There were no significant differences in intensity of treatment between lonely and non-lonely participants.

Loneliness is highly prevalent in older psychiatric outpatients, with men and women equally affected. Loneliness should be assessed in all older psychiatric patients, especially when they show high scores on symptom checklists or have a restricted social network.

Schutter et al. (2022) The association between loneliness and psychiatric symptomatology in older psychiatric outpatients. Journal of Geriatric Psychiatry and Neurology 35: 778-788.

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This talk will cover two common areas of confusion. First, the relationship between personal recovery and clinical recovery will be described, using recent meta-analytic evidence. It will be argued that personal recovery is not the same as clinical recovery, and that there is now an established policy and practice consensus that supporting personal recovery is the primary aim of mental health systems. Traditional clinical recovery-oriented treatments which target for example symptomatology or relapse prevention can for many people with mental health issues contribute to their recovery at points in their lives, but for others different approaches are needed. This variation in clinical need is addressed in the second area – patient-rated measures. The rationale for measures of experiential knowledge will be given. A distinction will be drawn between Patient-rated outcome measures (PROMs) and Patient-rated experience measures (PREMs), and between peer-developed patient-generated PROMs (PG-PROMs) compared with those developed by non-peer research teams. It will be argued that modern mental health systems should be judged by their impact on recovery, as measured using PROMs and PREMs in preference to staff-rated measures.

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Food addiction (FA) is characterized by poorly controlled intake of highly-palatable, calorically-dense, high-sugar, high-fat, and usually processed foods. Although not existing in the DSM-5 or ICD, it has been a widely discussed clinical and research entity for more than a decade, in the understanding of both obesity and also disordered eating behaviours. Most studies indicate that risk factors for FA are similar to substance use disorders. FA is also found to be linked with emotion regulation problems, impulsivity, distinct personality features, and other major psychopathologies including depression and anxiety. Morevoer, in several studies, female gender is found to be associated with more prevalent food addiction, up to 7 times. Female gender is also a predictor of severe food addiction, and high reward sensitivity was significantly associated with more severe FA symptoms in females. It is known that women are more likely to self-medicate than men in the acquisition phase of addiction and show a more rapid escalation of use than men (telescoping), whereas in general substance use disorders are much more common in men. The wide availability of hyperpalatable, high-calorie, and inexpensive food and the contextual and social factors that do not necessarily prevent women from consuming these drugs, contrary to that of illicit drugs, might explain why FA is more frequently observed in women than in men. Also, biological factors, hormonal changes and body-image disturbances might also be among the reasons why females are more affected from FA. Aspects related to gender should be taken into account for proper recognition and treatment of FA, a diagnosis of growing importance.

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Campaigns have been launched to make sense of what makes a specific individual suicidal. We know that suicidal individuals give definite warning signs, mainly from their ambivalence about ending their own lives. Classical suicidology posited that the suicidal individual experiences unbearable psychological pain (psychache) or suffering and that suicide might be, at least in part, an attempt to escape from this suffering, emphasizing that suicide is not a movement toward death but rather an escape from unbearable emotion and unendurable or unacceptable anguish. Suicide occurs when that individual deems the psychache to be unbearable. Neuroimaging studies demonstrated that such emotional pain shares the same neuroanatomical circuit of somatic pain. Furthermore, concepts related to death, failure, or other unfortunate circumstances activate specific cerebral areas in a suicidal individual compared to a non-suicidal subject. The author conducted a sizeable clinical investigation on mental pain related to psychiatric disorders and suicide risk. Implications for further research are discussed during the presentation.

M. Pompili Consultant of: Janssen, Lundbeck, Recordati, MSD, Speakers bureau of: Janssen, Lundbeck, Angelini Pharma, Pfizer

Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration.

We used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case-control study. We defined a set of 3 indicators of social disadvantage for each phase: pre-migration, migration, and post-migration.

249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95%CI 1.06-2.44, p=0.027) and postmigration social disadvantages (OR 1.89, 95%CI 1.02-3.51, p=0.044), along with expectations/achievements mismatch (OR 1.14, 95%CI 1.03-1.26, p=0.014) were all significantly associated with psychosis. We found a dose-response effect between number of adversities across all phases and odds of psychosis (≥6: OR 14.09, 95%CI 2.06-96-47, p=0.007).

The cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may be reduce the excess of psychosis in migrants.

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In the past two decades, social media has become the central way for many people, organizations, institutions to communicate and share opinions, ideas, and information. A young individual on average spends 2-3 hours on social media, engaging in 6-7 applications, which has also dramatically increased during/and after the pandemic. So far, there has been increasing evidence that social media influences behavior, including its own use. It has also been related with aggression towards self and others, and especially suicidal behaviour related (positively and negatively) with social media use has received growing academic and public interest. Excessive use of social media or addiction, exposure to negative content, stalking, cyberbullying and cybervictimization are among concepts which have an influence on (self-)aggressive behavior. Research has shown that adolescents are more vulnerable to cybervictimization than adults, and female adolescents, who spend more time on social media than males, are even more vulnerable, resulting in depressive and in some cases, suicidal ideation. Individuals in marginalized groups might also be more prone to be affected by excluding discourse or discriminatory posts. On the other hand, social media could serve as a coping mechanism given the possibilities for instant support from online networks, availability of psychoeducational resources and mental health related scientific content. Few meta-analyses in the field indicate the need to systematize sampling and data collection; while each pointing to the heterogeneity of the impact of social media. In this talk, the correlates of social media will be reviewed, and possible mental health-promoting approaches will be discussed.

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Behavioral addictions (with related behaviors often conducted online) constitute new categories within the Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD). In both, gambling disorder is listed as a formal clinical diagnosis whereas disorders related to videogaming exist in the DSM (research criteria) and ICD (clinical criteria). However, a broader range of disorders related to other behaviors (e.g., shopping/buying, social media use, pornography use) have been proposed as possible behavioral addictions.

This presentation will provide insight in efforts by major organizations (e.g., the World Health Organization) to consider behavioral addictions and how best to screen for, assess and intervene to help people with these conditions. Empirical data influencing the classification of the behaviors and disorders will be presented. Changes in online behaviors during the COVID-19 pandemic will be considered with respect to mental health concerns.

Multiple methods ranging from results of neuroimaging studies, clinical trials, and longitudinal investigations will be presented.

Brain imaging results suggest similarities between specific internet-use behaviors (especially internet gaming disorder) and substance use disorders, supporting a classification as behavioral addictions. Multiple types of internet use increased during the pandemic, particularly during the onset. Different patterns of mental concerns in relation to internet use behaviors were seen during the pandemic. Consensus guidances regarding how best to avoid and address problematic use of the internet were developed and disseminated. Clinical trials support the efficacy of behavioral and neuromodulatory approaches, although no treatments have regulatory approval for behavioral addictions.

Multiple internet-use behaviors may form the basis of behavioral addictions. While considerable data exist for internet gaming disorder, other behaviors commonly performed on the internet also warrant consideration. Additional research is needed to develop, test and implement more effective prevention and treatment strategies.

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Some evidence converges to consider that suicidal behaviour could be a separate diagnosis and emphasizes the relevance to identify specific biomarkers. Identifying the neural substrates of suicide attempt is key to understanding the etiology of suicide and might be helpful in reducing suicide rates among psychiatric patients by promoting the development of novel therapeutic strategies based on behavioral neuroscience and brain stimulation. Neuroimaging studies have reported structural and functional brain abnormalities located in the prefrontal cortex, insula and striatal regions as well as in the connections between these brain areas. Based on task related and resting state functional MRI studies, we will discuss original data showing the role of the ventral prefrontal cortex in suicide vulnerability.

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As the global resettlement needs are further increasing, the questions on refugee youths’ wellbeing arise. The experience of migration during childhood might interfere with the developmental trajectories in different ways. Refugee youths might be at higher risk of violence, abuse and mental health problems.

This study aimed to explore the prevalence of alcohol and substance use among young refugees, along with the indicators of experienced psychological difficulties.

Data collection was followed by numerous difficulties–C-19 pandemic, linguistic diversity and high respondents’ illiteracy rate.

The sample consisted of 184 participants aged 11–18 years. More than a half of them displayed symptoms of PTSD - more frequently females, those who resided in a greater number of refugee centers and those who were exposed to abuse and domestic violence. Half of the respondents consumed energy drinks, slightly less than a third of them used tobacco, 13% consumed alcohol, 4.6% marijuana, whereby the frequency of other substance use was significantly lower. The significant indicators of individual propensity to use alcohol and substances were shown to be older age (14-18 years), male gender, lower education, being unaccompanied child and exposure to emotional abuse.

Our research confirmed that young refugees, especially unaccompanied, might be at higher risk for mental health difficulties. Research on this topic should aim to link scientific data to sustainable practices, applicable in everyday life.

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The digital revolution is evolving at an unstoppable pace. The dissemination of interconnected networks, the growth and spread of new digital technology across all ages at different levels, has rapidly led to an increasing usage of the Internet, smartphones and digital social networking, particularly among young people. Smartphones, social networking and digital videogaming platforms are currently being used as primary means of online access, source of information and as preferred mode for social communication and peer interaction. However, despite digital world is progressively replacing the ‘physical world’ concerning socialization process and communication modalities, there is poor attention on the ‘digital trauma load’ experienced by individuals belonging to the Z and alpha generations in term of potential impact of digital instruments on mental health.

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The COVID-19 pandemic has caused immense psychosocial strain worldwide. Excessive use of the internet during these psychologically trying times, fueled by physical isolation as a result of lockdowns, translated into dysfunctional behaviors. A growing body of evidence suggests an unprecedented increase in internet use and consumption of online pornography during the pandemic, and possibly even directly caused by it. This presentation will focus on the the statistics, variations in diagnostic criteria, clinical presentations and interventions for problematic online pornography use. Practical solutions will be offered to show how foresightedness with utilizing existing tools and therapies and exercising appropriate amounts of caution could go a long way in addressing the challenges that lie ahead in the post-pandemic era.

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Deep brain stimulation (DBS) of brain circuits involved in mood regulation is a novel tool that is being investigated as a potential treatment for some of the most severe patients with mood disorders. At UTHealth Houston, we have had an ongoing clinical trial with DBS of the medial forebrain bundle (MFB).

Our preliminary results suggest effects in alleviating depressive symptoms in this very severe, refractory patient group.

In this presentation, we will review our latest findings, and will also discuss the potential effects of the MFB stimulation on measures of suicidality in this patient population.

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